WHAT'S UP DOC? Drowning

Q: Summer is almost here, and I am wondering how big a concern is drowning?

A: Drowning is dying due to lack of oxygen from submersion in a liquid. Near-drowning is when the patient is significantly deprived of oxygen due to submersion in liquid, but does not immediately die.

Drownings are not uncommon, and they are more common in the warmer months. Worldwide up to 500,000 people drown each year, with 4000 and 6500 of these in the U.S. Swimming incidents cause 40-50 percent of drownings, boating 15-20 percent and other causes the rest.

It is not known how common near-drownings are since many may not come to medical attention. Bad prognostic indicators in near-drowning include longer submersion (especially if it is greater than 5 minutes, and this is the most critical factor), delayed or long resuscitation, and others.

In about 85 percent of immediate drowning deaths, fluid gets into the lungs and compromises the ability to fill the lungs with sufficient air. This may take as little as half an ounce per ten pounds of body weight of the victim, so a 120-pound drowning victim might have only 6 ounces of fluid in their lungs.

When fluid starts to enter the trachea (the big air tube in your throat that leads to the lungs) the vocal cords spasm to close it off. If this laryngospasm does not relax fast enough, it can prevent air from getting to the lungs and lead to death. Laryngospasm is responsible for up to 15 percent of drownings, and in these patients there is only minimal fluid in the lungs. This phenomenon can occur in a delayed fashion, even up to 24 hours or longer after the patient has been removed from the water, and is sometimes called ‘dry drowning.’

Secondary drowning is due to an inflammatory/swelling reaction in the lungs from having previously inhaled water. The symptoms of this relatively rare complication usually develop within a day or two of the near-drowning incident (but can occur later), and include shortness of breath, coughing, lethargy, chest pain, fever and/or behavior/mood changes, and can potentially progress to respiratory compromise and even death.

Children account for 80 percent of all drownings; they are the second leading cause of death from injury for kids under 14 and the leading cause for kids between 1 and 4 (accounting for 25 percent of all deaths in this age group).

For kids less than 4, drowning occurs most often in or around the home, in bathtubs, buckets or toilets. Teenagers drown most often in pools or lakes, and unfortunately alcohol or drugs are too frequently implicated as a factor in these tragic events.

For every child that drowns there are about 15 more who present to the Emergency Department having almost drowned. For every child with severe enough consequences to require hospital admission from near-drowning, about 15 percent die and another 20 percent have subsequent neurologic compromise.

Most drowning and near-drowning victims don’t splash or make noise; instead there is usually a sudden inhalation of fluid (either entering the lungs or triggering laryngospasm) with the patient rapidly losing consciousness. Most young children who drown are out of their caretaker’s (most commonly parents) sight for less than five minutes, and are discovered within a couple of minutes of becoming submerged.

For any drowning victim, including secondary drowning victims, treatment for respiratory compromise includes supplemental oxygen and, if needed, a breathing tube to aggressively assist in breathing. Even for secondary drowning there is no evidence that steroids (to treat the presumed inflammatory component) or antibiotics (to treat potential infectious contribution) are overall helpful, but these may be administered in selected patients.

To minimize the risk of drowning:

Never swim alone.
When you are supervising people swimming they should have your undivided attention.
All pools should have barriers to limit unsupervised access. Toys should not be left around the pool to tempt children.
Coast Guard approved personal flotation devices (PFDs) should be used for boating and in other appropriate situations. Inflatable air floats are not replacements for PFDs.
When swimming at the beach stay close to the lifeguard station to be more easily seen.
Do not dive anywhere (pools, lakes, etc.) that does not have sufficient depth.
Be sure your kids learn to swim, but don’t overestimate their swimming skills, or your own.

Swimming can be great fun and is good exercise. With appropriate caution, water activities can be a safe and enjoyable way to spend those long, hot, humid summer days.